This study validated the Portuguese short-form version of the Child and Adolescent Mindfulness Measure (CAMM-5-PT) in a large adolescent sample. A total of 2,345 adolescents (12–18 years) completed the CAMM-5-PT and several psychological measures. Confirmatory factor analysis, reliability, test–retest stability, measurement invariance across gender and school grade, convergent and divergent validity and incremental validity were examined. The CAMM-5-PT showed excellent fit for a unidimensional structure, strong internal consistency, and high test–retest reliability. Invariance was supported across gender and school grade. Boys reported higher mindfulness than girls. The CAMM-5-PT correlated positively with psychological flexibility, self-compassion, and well-being, and negatively with rumination, psychological inflexibility, and emotional symptoms. Hierarchical regressions demonstrated incremental predictive validity for depression, anxiety, stress, and well-being beyond psychological flexibility, psychological inflexibility, rumination and self-compassion. The CAMM-5-PT is a psychometrically sound, efficient tool for assessing adolescent mindfulness in educational and research contexts.

The COVID-19 pandemic and lockdown experience required finding new resources and lifestyle changes. Understanding people’s behaviors during the pandemic and its potential effects on mental health indicators and well-being is essential for future directions. This study aimed to compare mental health symptoms during Portugal’s first lockdown with normative data, analyze the perceived utility of activities during this period, and explore how these perceptions related to individuals’ mental health indicators and emotion regulation processes (e.g., mindfulness and compassion). A sample comprising 238 (186 women and 52 men) participants completed an online survey during the first lockdown of the COVID-19 pandemic in April (M1) and June (M2) 2020. The survey addressed the perceived utility of various activities to deal with the lockdown (e.g., exercise). It also included self-report measures of psychopathological symptoms and emotion regulation processes. No differences were found between depression and anxiety scores (at M1 and M2) and Portuguese normative pre-pandemic data. During the lockdown, perceived stress was higher than normative data. Reading, being outdoors, talking with friends, video calls, and helping others were scored as very useful. Mean comparisons of emotion regulation processes and psychopathological symptoms based on the utility of activities to deal with the lockdown were reported. Activities related to meaningful connections with others and personal activities may be encouraged as protective activities buffering the potentially harmful effect of isolation and external and uncontrollable threats. These findings highlighted the importance of promoting personal health behaviors and emphasize real social connections (e.g., social activities prescriptions).

The literature has consistently shown the link between parental depressive symptoms and adolescent depressive symptoms. Emotion regulation processes may explain this association, with self-compassion acting as a potential mediating mechanism. This study aimed to explore these developmental trajectories using a longitudinal design. The sample comprised dyads of parents and adolescents (N = 311), assessed across two assessment waves (T1 and T2) over 12 months. The adolescents' mean age was 13.63 years (SD = 1.30; 173 males). Mediation analyses using structural equation modelling supported the role of self-compassion in mediating the relationship between parental and adolescent depressive symptoms over time (53% of outcome variance explained). The results suggest that fostering self-compassion early in adolescence may help prevent the later adverse effects of depressive symptoms.

OBJECTIVE:To develop and test the effectiveness of the eBEfree program, a 12-session app-based version of a previously tested psychological intervention (BEfree) that combines psycho-education, self-compassion, mindfulness, and Acceptance and Commitment Therapy to reduce binge-eating symptoms. METHOD:Two-hundred participants with recurrent elevated binge-eating symptoms and a higher body weight were enrolled in a remote parallel-group randomized trial, of which 142 completed the initial assessment (70 in the intervention group). The end-of-treatment and follow-up assessments were conducted 12 weeks after the initial assessment and 26 weeks after the end of treatment, respectively. Intention-to-treat (ITT) analyzes were undertaken using frequentist linear mixed models and Bayesian hierarchical models to test the intervention effectiveness. RESULTS:43 (waitlist control) and 29 (intervention) participants completed the end-of-treatment assessment, showing a high attrition rate (51%). ITT analyzes showed the eBEfree program to be associated with a significant reduction in binge eating symptomatology from baseline to end-of-treatment (β = -9.49, ρ < 0.0001, g = -1.17), and from end-of-treatment to 26-weeks follow-up (β = -6.01, ρ = 0.04, g = -1.08). At end-of-treatment, the intervention was also associated with a decrease in body mass index and depression symptomatology, as well as an improvement in dimensions of self-criticism and mindfulness. More than 80% of participants rated the quality of the program as positive and helpful. DISCUSSION:This trial suggests potential benefits of the eBEfree program to help individuals manage symptoms of binge-eating more effectively, reduce weight, and improve well-being and mental health. The intervention benefits should be confirmed in future larger trials. PUBLIC SIGNIFICANCE:Treating binge-eating (BE) symptoms and associated comorbidities might be challenging for mental health services. Digital and app-based interventions can be a valuable resource to help people manage symptoms and improve well-being and mental health. The current trial suggests the potential benefits of an app-based intervention (eBEfree program) to help people reduce BE symptoms and develop psychological strategies to promote well-being and mental health. TRIAL REGISTRATION:Clinicaltrials.gov: NCT04101032 ("eBEfree-an ICT Adaptation of BEfree").

The COVID-19 pandemic generated distinct mental health challenges, characterised by stress and anxiety due to its unpredictable duration and continuous threat. This study examined the role of meditation practice on anxiety symptoms and perceived stress, considering co-variables such as self-compassion, acceptance, awareness, brooding, lockdown duration, and sociodemographic characteristics. The study used a longitudinal design and data were collected through online surveys from April 2020 to January 2021 (at four different time points) and included 238 participants from Portugal (165 had prior experience with meditation practices, 73 were non-meditators) with a mean age of 43.08 years (SD = 10.96). Linear mixed models revealed that over time, during the lockdown, the non-meditators group demonstrated a greater increase of anxiety symptoms (beta = -0.226, SE = 0.06, p = 0.006) and perceived stress (beta = -0.20, SE = 0.06, p = 0.004), whereas the meditators group showed non-significant (p > 0.05) variations in anxiety and stress symptoms during the same period of time. The effect of meditation on anxiety symptoms was moderated by sex, days of lockdown, self-compassion, and acceptance. The effect of meditation on perceived stress was moderated by sex, years of education, days of lockdown, and levels of awareness. Additionally, the study explored the potential predictive effect of different meditation session lengths, indicating that longer meditation practices offered greater protection against an increase in anxiety symptoms. These findings highlight the importance of cultivating self-regulation skills and investing in preventive mental health strategies to promote well-being and autonomy. Mental health professionals should prioritise educating communities on evidence-based practices like meditation and compassion exercises to enhance overall health.

IntroductionFertility patients increasingly use web-based and mobile-based apps to access psychosocial care. These digital tools may be a helpful alternative to traditional psychological interventions. Developing and evaluating patient-centred e-mental health tools rooted in evidence-based interventions is a priority. The KindMap is a stand-alone, cost-free e-mental health intervention derived from adapting the Mindfulness Based Programme for Infertility (MBPI) contents to a digital format. The KindMap integrates mindfulness and self-compassion skills training and Acceptance and Commitment Therapy components. This protocol is intended to evaluate the KindMap’s feasibility and explore the extent to which the web-app mode of delivery limited efficacy results are similar to the MBPI in-person format results. Furthermore, it will test the causal theory underlying KindMap.Methods and analysisA two-arm 2:1 non-blinded feasibility randomised controlled trial (RCT) will be conducted. Participants are people dealing with infertility, who are able to access the Internet and understand Portuguese or English. Consent participants will complete an online survey at 3-time assessment moments. After baseline assessment, participants will be randomised into the KindMap experimental group (KindMap-EG; with immediate access to the web app) or the waiting-list control group. The primary outcome is well-being (WHO Index-5); secondary outcomes are infertility-related stress (Fertility Problem Inventory—Short Form), anxiety and depression (Patient Health Questionnaire for Depression and Anxiety-4); mindfulness (Five Facet Mindfulness Questionnaire—Short Form), self-compassion (Self-Compassion Scale—Short Form), psychological flexibility (Psy-Flex) and infertility-related self-efficacy are the potential mechanisms of change. KindMap-EG will also complete a feasibility survey.Ethics and disseminationThe study was approved by the Ethics Committee of the Faculty of Psychology and Educational Sciences of the University of Coimbra (Identifier: CEDI/FPCEUC:78/R_10). The KindMap study may contribute to the existing research on e-health technologies applied to mental health. The study outcomes will be disseminated through publications in peer-reviewed journals and national and international conference presentations.Trial registration numberNCT05899374.

BackgroundChronic pain (CP) has serious medical and social consequences and leads to economic burden that threatens the sustainability of healthcare services. Thus, optimized management of pain tools to support CP patients in adjusting to their condition and improving their quality of life is timely. Although acceptance and commitment therapy (ACT) is considered an evidence-based psychological approach for CP, evidence for the efficacy of online-delivered ACT for CP is still scarce. At the same time, studies suggest that self-compassion mediates the change in disability and psychopathological symptoms in ACT interventions for CP, although self-compassion is not a specific target in ACT. Thus, an explicit focus on self-compassion might increase the efficacy of ACT interventions for CP, although this hypothesis has not been tested. This study aims to develop an eHealth ACT and compassion-based self-management intervention for CP, the iACTwithPain, and to compare its efficacy in improving health outcomes to a similar ACT-only intervention and a medical TAU group.MethodsThe eHealth platform that will host the interventions will be developed using a flat design identity and will be interactive. The iACTwithPain intervention will comprise eight weekly self-management sessions and will be developed taking into consideration the psychological flexibility model applied to CP, with the addition of explicit compassion-based components. To analyze whether the iACTwithPain intervention will present superiority in improving CP’s impact and related health markers over the two other conditions, this study will follow an RCT design with three arms. CP patients will be recruited through direct contact with patient associations and healthcare services and a national press release in Portugal. Outcome measurement will be conducted at baseline, post-intervention and at 3- and 6-month follow-ups. The interventions’ acceptability will also be assessed.DiscussionThe iACTwithPain intervention is expected to improve CP patients’ psychosocial functioning, quality of life, and empowerment, by promoting adaptive disease management and regulation of pain-related internal experiences. Results will contribute to a better understanding on the pertinence of adding compassion elements to ACT for CP and to reach an optimized intervention for CP.Clinical Trial RegistrationThis trial has been registered at ClinicalTrials.Gov (NCT04200183; 16 December 2019; https://clinicaltrials.gov/ct2/show/NCT04200183). The current manuscript comprises the first version of this clinical trial’s protocol.

We examined 12 monogenic obesity genes in 72 Portuguese individuals with overweight and obesity (class 1 and class 2), some of which with suspected genetic obesity, to identify known or unknown potential obesity variants. Genomic DNA was analyzed for variants in genes LEP, LEPR, MC4R, POMC, PCSK1, BDNF, NTRK2, SIM1, SH2B1, UCP3, GCG and ADCY3 through next generation sequencing (NGS). The impact of the rare variants was investigated in the ClinVar database and using in silico tools for prediction of pathogenicity. Four potential pathogenic missense variants were detected at the heterozygous state in five individuals: two in the ADCY3 gene, NM_004036.5:c.1153G > A (p.Val385Ile) (rs756783003) and NM_004036.5:c.1222G > A (p.Gly408Arg) (rs201606553), one in gene SH2B1, NM_001145795.1:c.127C > A (p.Arg43Ser) (rs547678855), and the fourth in gene POMC NM_000939.4:c.706C > G (p.Arg236Gly) (rs28932472), which was found in two individuals. Moreover, six rare variants near splicing sites were also identified, as well as eight rare synonymous variants. In summary, some potential pathogenic rare missense variants were identified, two of them in ADCY3 gene, the most recently identified gene as having a role in monogenic obesity. Further analysis should be performed to confirm the clinical relevance of these variants.

Objective To explore a novel model for war-related posttraumatic stress disorder (PTSD) symptomatology including emotion regulation processes, namely experiential avoidance (EA) and uncompassionate self-responding (USR), mediating the impact of childhood threat memories, combat exposure distress, combat and noncombat threats, and peritraumatic depersonalization/derealization (PDD) on PTSD symptomatology. Method A sample of 650 male Portuguese Overseas War veterans filled self-report instruments. Results The model explained 59% of the variance of PTSD symptomatology. Both EA and USR mediated the effects of noncombat threats and PDD on PTSD. Additionally, EA mediated combat exposure distress and USR mediated childhood threat memories. Combat exposure distress, combat and noncombat threats, and PDD showed direct effects on PTSD symptomatology. Conclusion The findings help to better understand the relationship between predictive factors of war-related PTSD in clinical and research settings, providing novel insights on the effects of combat exposure distress, and the different effects of combat and noncombat-related threats on PTSD.

Meditation practice has beneficial effects on physical and mental health, and barriers to regular practice have been recognized. The Determinants of Meditation Practice Inventory (DMPI) was developed and recently revised (DMPI-R). DMPI-R is a 12-item self-report instrument encompassing four dimensions: low perceived benefit, perceived inadequate knowledge, perceived pragmatic barriers, and perceived socio-cultural conflict. The current study aimed to investigate the psychometric properties and factor structure of the European Portuguese version of the DMPI-R in a general population Portuguese sample (non-meditators). A sample comprising 154 participants completed a set of self-report measures online. Exploratory factor analysis (EFA) and parallel analyses were conducted to decide on the number of factors. Confirmatory factor analysis (CFA) was computed in an independent sample (N = 229). Three models were tested and compared. Reliability and validity were analyzed. The EFA and parallel analysis revealed a four-factor structure. The three models tested showed a good fit to the data. Models’ comparison pointed that the four-factor model, excluding item 10, was the one with the lower Expected Cross-Validation Index. The DMPI-R factors revealed adequate reliability and test–retest stability. The DMPI-R showed correlations with experiential avoidance and perspectives on meditation. No significant differences were found between men and women on the DMPI-R four factors. No significant associations with age and years of education were found. The European Portuguese version of DMPI-R is a reliable and valid self-report instrument to assess perceived barriers to meditation, contributing to expand research and support meditation instructors in improving meditation programs.

BackgroundThis pilot study aims to test the usability of the iACTwithPain platform, an online ACT-based intervention for people with chronic pain, to obtain information on which intervention and usability aspects need improvement and on expected retention rates.MethodsSeventy-three Portuguese women with chronic pain were invited to complete the first three sessions of the iACTwithPain intervention assess their quality, usefulness and the platform’s usability. Twenty-one accepted the invitation. Additionally, eight healthcare professionals working with chronic medical conditions assessed the platform and the intervention from a practitioner’s point of view.ResultsThis study presented a considerable attrition rate (71.43%) among chronic pain participants, with six completers. There were no significant differences in demographic or clinical variables between dropouts and completers except for completed education (participants who dropped out presented less education than completers). Reasons for dropout were related to difficult personal events occurring during the time of the intervention, lack of time, or having forgotten. There seemed to be an overall satisfaction with both the intervention, its contents and form of presentation of information, and the platform, concerning its design, appearance, and usability. Real image videos were preferred over animations or audio by chronic pain participants. Healthcare professionals emphasized the appealing and dynamic aspects of the animation format.ConclusionThis study informs the ongoing improvement of the iACTwithPain platform and provides valuable information on aspects researchers should consider while developing online psychological interventions for chronic pain. Further implications are discussed.

Objectives Evidence shows that Acceptance and Commitment Therapy (ACT) is an empirically supported psychological approach for chronic pain (CP) management. Although self-compassion is not explicitly a target of ACT, it seems to be one mechanism of change in ACT for CP. However, research is lacking on the benefits of including explicit self-compassionate exercises in ACT for CP. The current study pilot tested a Compassionate ACT 8-session group program (COMP.ACT; n=9), as well as an ACT-only 8-session group program (ACT; n=7), in a sample of women with CP. Methods The current study follows a quasi-experimental design, and conducts Reliable and Significant Change analyses comparing pre- to post-intervention scores of self-report measures. Results No differences were found between conditions at baseline, nor between completers and drop-outs. Although preliminary, results showed COMP.ACT led to greater clinical improvements in depression and anxiety, while ACT led to greater improvements in stress and uncompassionate self-responding. Reliable and Significant Change analysis showed that some participants improved significantly (in psychopathological symptoms, valued living and uncompassionate self-responding) in both conditions, while the majority did not change significantly. Conclusions More research is needed to conclude whether explicit self-compassion exercises are useful in ACT for CP. Limitations and implications are further discussed.

Acceptance and Commitment Therapy (ACT) has been widely tested for chronic pain, with demonstrated efficacy. Nevertheless, although there is meta-analytical evidence on the efficacy of face-to-face ACT, no reviews have been performed on online ACT in this population. The aim of this meta-analysis is to determine the efficacy of online ACT for adults with chronic pain, when compared with controls. PubMed, PsycINFO, CENTRAL, and Web of Knowledge were searched for randomized controlled trials (RCTs) of online-delivered ACT for chronic pain. Effects were analyzed at post-treatment and follow-up, by calculating standardized mean differences. Online-delivered ACT was generally favored over controls (5 RCTs, N = 746). At post-treatment, medium effects for pain interference and pain acceptance, and small effects for depression, mindfulness, and psychological flexibility were found. A medium effect for pain interference and acceptance, and small effects for pain intensity, depression, anxiety, mindfulness, and psychological flexibility were found at followup. ACT-related effects for pain interference, pain intensity, mindfulness, and anxiety increased from post-treatment to follow-up. Nevertheless, the current findings also highlight the need for more methodologically robust RCTs. Future trials should compare online ACT with active treatments, and use measurement methods with low bias. Perspective: This is the first meta-analytical review on the efficacy of online ACT for people with chronic pain. It comprises 5 RCTs that compared online ACT with active and/or inactive controls. Online ACT was more efficacious than controls regarding pain interference, pain intensity, depression, anxiety, mindfulness, and psychological flexibility. (C) 2021 by United States Association for the Study of Pain, Inc.

Objectives The current study aimed to examine the mechanisms of change that mediate the impact of a compassionate mind training (CMT) intervention, in particular, whether changes in compassion, fears of compassion and heart rate variability (HRV) would mediate the effects of a brief CMT intervention on psychological vulnerability factors, mental health indicators and positive affect. Methods Using a longitudinal design, general population participants were randomly assigned to one of the two conditions: compassionate mind training (n = 56) and wait list control (n = 37). Participants in the CMT condition attended a psychoeducation session and practiced a set of core CMT exercises for 2 weeks. Self-report measures of compassion, fears of compassion, self-criticism, shame, depression, stress and positive affect were completed, and HRV was assessed at pre- and post-intervention. Results Mediation analyses revealed that increases in compassion for self and from others and reductions in fears of compassion for self, for others and from others mediated the effects of CMT on self-criticism and shame. In depression and stress, compassion for the self and from others and fears of compassion for the self emerged as significant mediators. Compassion for the self and from others and fears of compassion for self and from others significantly mediated the effect of CMT in safe affect. Compassion for the self, fears of compassion for self and for others and HRV mediated changes in relaxed affect. Conclusions Cultivating a compassionate mind/self-identity through the core components of CMT may stimulate vagal regulatory activity and positively impact one's ability to experience and be open to compassion, and thus promote emotion regulation, well-being and mental health.

CFQ-CI was previously developed and preliminarily validated in a study with a single online-recruited inflammatory bowel disease (IBD) sample. The current study presents a further validation of CFQ-CI in four different samples of patients with chronic health conditions: a sample of 82 women with breast cancer, an online-recruited mixed sample of 100 people with cancer, a sample of 69 people with IBD, and an online-recruited mixed chronic illness sample of 93 participants. Confirmatory Factor Analyses, multi-group, reliability, and differences analyses were conducted. Results indicated that the scale is a robust unidimensional 7-item measure of chronic illness-related cognitive-fusion, with excellent reliability and structural validity across the four studied samples and in both paper-pencil- and online-based collection methods. Measurement invariance was not established across the samples, suggesting that CFQ-CI does not appear tofunction equivalently across different illness diagnoses. This study confirms CFQ-CI as a robust, adequate, and simple measure of chronic illness-related cognitive fusion that can be used in different behavioural medicine research and clinical contexts. As the scale does not seem to present measurement invariance, comparing scores between different illness groups is not recommended.

Cognitive fusion refers to the dominance of verbal processes over behavior regulation, in detriment of being sensitive to contextual contingencies and pursuing valued life goals. It is a core process within Acceptance and Commitment Therapy and seems to have a crucial role in the development and maintenance of psychopathology. The first goal of this investigation was to explore the factor structure, factorial invariance and psychometrics of the Portuguese version of the Cognitive Fusion Questionnaire (CFQ). A multigroup confirmatory factor analysis attested the invariant one-dimensional factor structure of the CFQ across three samples from the general population (n = 408; n = 291; n = 101) with different demographic characteristics. Additionally, the CFQ showed to be a psychometrically robust and reliable measure. A second major goal was to investigate the convergent and incremental validity of this version of CFQ (n = 408). Convergent validity was explored and attested with several psychological indicators. Regarding incremental validity, the predictive power of depressive symptoms of cognitive fusion and three related processes, with origin in different conceptual frameworks, was tested. Results showed that even when the effects of decentering, mindfulness and metacognitions were controlled for, cognitive fusion consistently maintained a significant and unique predictive power over depressive symptoms. These findings suggest that these processes relate differentially and independently with depressive symptoms and, moreover, that cognitive fusion has a superior contribution to its explanation. Given the evidence that cognitive fusion plays an important role in the comprehension of depressive symptoms, conceptual and clinical implications were discussed.

OBJECTIVE This psychometric study explores the Portuguese version of the Posttraumatic Stress Disorder (PTSD) Checklist (PCL-5). It aims to clarify the best-fitting latent structure among competing PTSD models (Diagnostic and Statistical Manual of Mental Disorders-fifth edition [DSM-5], Dysphoria, Dysphoric Arousal, Anhedonia, Externalizing Behavior, And Hybrid models) and its implications for PTSD measurement. METHOD Psychometric analyses were conducted in a sample from the general population of firefighters (N = 446), except the temporal stability, which was tested in a subsample of 100 participants. RESULTS The models presented significant differences in a global fit. The Hybrid model presented the best-fitting structure, but the DSM-5 model showed more favorable reliability and convergent validity in Confirmatory Factor Analyses. The DSM-5 model also proved to be internally consistency, temporally stable, and presented convergent validity. CONCLUSION The Portuguese version of PCL-5 is reliable and valid. The findings suggest the appropriateness of the DSM-5 model to assess PTSD symptomatology, encouraging its use in clinical, and research settings.